Objective This study aimed to comprehensively analyze and compare the clinicopathological features and prognosis of Chinese patients with human epidermal growth factor receptor 2(HER2)-low early breast cancer(BC)and HER2-IHC0 BC. Methods Patients diagnosed with HER2-negative BC(N=999)at our institution between January 2011 and December 2015 formed our study population.Clinicopathological characteristics,association between estrogen receptor(ER)expression and HER2-low,and evolution of HER2 immunohistochemical(IHC)score were assessed.Kaplan-Meier method and log-rank test were used to compare the long-term survival outcomes(5-year follow-up)between the HER2-IHC0 and HER2-low groups. Results HER2-low BC group tended to demonstrate high expression of ER and more progesterone receptor(PgR)positivity than HER2-IHC0 BC group(P<0.001).The rate of HER2-low status increased with increasing ER expression levels(Mantel-Haenszel χ2 test,P<0.001,Pearson's R=0.159,P<0.001).Survival analysis revealed a significantly longer overall survival(OS)in HER2-low BC group than in HER2-IHC0 group(P=0.007)in the whole cohort and the hormone receptor(HR)-negative group.There were no significant differences between the two groups in terms of disease-free survival(DFS).The discordance rate of HER2 IHC scores between primary and metastatic sites was 36.84%. Conclusion HER2-low BC may not be regarded as a unique BC group in this population-based study due to similar clinicopathological features and prognostic roles.

Objective: To explore the clinical characteristics of various types of infected pancreatic necrosis(IPN) and the prognosis of different treatment methods in the imaging classification of IPN proposed. Methods: The clinical data of 126 patients with IPN admitted to the Department of Pancreatic and Biliary Surgery, the First Affiliated Hospital of Harbin Medical University from December 2018 to December 2021 were analyzed retrospectively. There were 70 males(55.6%) and 56 females(44.4%), with age(M(IQR)) of 44(17)years (range: 12 to 87 years). There were 67 cases(53.2%) of severe acute pancreatitis and 59 cases (46.8%) of moderately severe acute pancreatitis. All cases were based on the diagnostic criteria of IPN. All cases were divided into Type Ⅰ(central IPN)(n=21), Type Ⅱ(peripheral IPN)(n=23), Type Ⅲ(mixed IPN)(n=74) and Type Ⅳ(isolated IPN)(n=8) according to the different sites of infection and necrosis on CT.According to different treatment strategies,they were divided into Step-up group(n=109) and Step-jump group(n=17). The clinical indicators and prognosis of each group were observed and analyzed by ANOVA,t-test,χ² test or Fisher exact test,respectively. Results: There was no significant difference in mortality, complication rate and complication grade in each type of IPN(all P>0.05). Compared with other types of patients, the length of stay (69(40)days vs. 19(19)days) and hospitalization expenses(323 000(419 000)yuan vs. 60 000(78 000)yuan) were significantly increased in Type Ⅳ IPN(Z=-4.041, -3.972; both P<0.01). The incidence of postoperative residual infection of Type Ⅳ IPN was significantly higher than that of other types (χ²=16.350,P<0.01). There was no significant difference in the mortality of patients with different types of IPN between different treatment groups. The length of stay and hospitalization expenses of patients in the Step-up group were significantly less than those in the Step-jump group(19(20)days vs. 33(35)days, Z=-2.052, P=0.040;59 000(80 000)yuan vs. 122 000(109 000)yuan,Z=-2.317,P=0.020). Among the patients in Type Ⅳ IPN, the hospitalization expenses of Step-up group was significantly higher than that of Step-jump group(330 000(578 000)yuan vs. 141 000 yuan,Z=-2.000,P=0.046). The incidence of postoperative residual infection of Step-up group(17.4%(19/109)) was significantly lower than that of Step-jump group(10/17)(χ²=11.980, P=0.001). Conclusions: Type Ⅳ IPN is more serious than the other three types. It causes longer length of stay and more hospitalization expenses. The step-up approach is safe and effective in the treatment of IPN. However, for infected lesions which are deep in place,difficult to reach by conventional drainage methods, or mainly exhibit "dry necrosis", choosing the step-jump approach is a more positive choice.
Male ; Female ; Humans ; Retrospective Studies ; Pancreatitis, Acute Necrotizing/complications* ; Acute Disease ; Intraabdominal Infections/complications* ; Necrosis/complications* ; Treatment Outcome

Child ; Cytomegalovirus Infections ; Haplotypes ; Hematopoietic Stem Cell Transplantation ; Humans

Objective: To investigate the incidence and clinical features to probe the risk factors of hemorrhagic cystitis (HC) in children and adolescents with hematological diseases post haplo-hematopoietic stem cell transplantation (haplo-HSCT) . Methods: Medical records of 62 children and 27 adolescents with hematological diseases treated with haplo-HSCT between 2015 and 2016 were analyzed. Results: Of 89 cases (56 boys and 33 girls) , 44 patients were diagnosed with ALL, 33 AML, 3 AHL and 9 MDS. HC occurred in 32 of the 89 patients with an incidence of 36%, including 6 with grade Ⅰ, 16 with grade Ⅱ, 8 with grade Ⅲ, 2 with grade Ⅳ HC, respectively. The median time of HC onset was 25 days (range 2-55 days) after haplo-HSCT with the median duration as 19 days (range 3-95 days) , all of them were cured. The incidence of HC was lower in the group of children than that in the group of adolescents (27.4% vs 55.6%, χ(2)=6.466, P<0.05) , and the incidence of HC was higher in the group of patients who were ≥5 years old than that in the group of patients who were <5 years old (0 vs 34%, χ(2)=4.043, P<0.05) . Conclusion: HC is one of common complications in children and adolescents with hematological diseases post haplo-HSCT, older age was associated with increased mortality.
Adolescent ; Child ; Child, Preschool ; Cystitis ; Female ; Hematologic Diseases ; Hematopoietic Stem Cell Transplantation ; Humans ; Incidence ; Male ; Retrospective Studies ; Risk Factors

BACKGROUNDIt is still a challenge for the cardiac surgeons to achieve adequate revascularization for diffused coronary artery disease (CAD). Coronary endarterectomy (CE) offers an alternative choice of coronary artery reconstruction and revascularization. In this study, short-term result of CE combined with coronary artery bypass graft (CABG) was discussed in the treatment for the diffused CAD.

METHODSFrom January 2012 to April 2014, 221 cases of CABG were performed by the same surgeon in our unit. Among these cases, 38 cases of CE + CABG were performed, which was about 17.2% (38/221) of the cohort. All these patients were divided into two groups: CE + CABG group (Group A) and CABG alone group (Group B). All clinical data were compared between the two groups, and postoperative complications and in-hospital mortality were analyzed. The categorical and continuous variables were analyzed by Chi-square test and Student's t-test respectively.

RESULTSDiabetes mellitus, hypertension, hyperlipidemia, and peripheral vascular disease were more common in group A. In this cohort, a total of 50 vessels were endarterectomized. Among them, CE was performed on left anterior descending artery in 11 cases, on right coronary artery in 29 cases, on diagonal artery in 3 cases, on intermediate artery in 2 cases, on obtuse marginal artery in 5 cases. There was no hospital mortality in both groups. The intro-aortic balloon pump was required in 3 cases in Group A (3/38), which was more often than that in Group B (3/183). At the time of follow-up, coronary computed tomography angiogram showed all the grafts with CE were patent (50/50). There is no cardio-related mortality in both groups. All these patients were free from coronary re-intervention.

CONCLUSIONSCoronary endarterectomy + CABG can offer satisfactory result for patients with diffused CAD in a short-term after the operation.

Aged ; Coronary Artery Bypass ; adverse effects ; methods ; Coronary Artery Disease ; surgery ; Endarterectomy ; methods ; Female ; Hospital Mortality ; Humans ; Male ; Middle Aged ; Peripheral Vascular Diseases ; surgery ; Postoperative Complications ; Treatment Outcome

OBJECTIVETo investigate the factors related to clinical pregnancy outcomes of in vitro fertilization-embryo transfer (IVF-ET) in women with secondary infertility.

METHODSThe clinical, laboratory and follow-up data of 1129 cycles in 1099 patients with secondary infertility undergoing IVF-ET in Women's Hospital, Zhejiang University School of Medicine between July 2012 to July 2014 were retrospectively reviewed. The factors related to pregnancy outcomes were analyzed by univariate and logistic regression methods. The clinical pregnancy rates in women with different age and different number of embryos transferred were compared. The clinical outcomes of stimulation with gonadotropin releasing hormone (GnRH) agonist long protocol, GnRH agonist short protocol and GnH antagonist protocol were evaluated in secondary infertile patients aged ≥ 40 years.

RESULTSAmong 1129 cycles, 376 cases (33.30%) had clinical pregnancy and 753 cases (66.70%) had no clinical pregnancy. There were significant differences in age, body mass index, basal follicle-stimulating hormone level, antral follicle number,paternal age and number of embryos transferred between pregnancy and no pregnancy groups (P<0.05); while only maternal age (OR=0.900, 95% CI: 0.873~0.928, P<0.001) and the number of embryos transferred (OR=2.248, 95% CI: 1.906~2.652, P<0.001) were the independent factors affecting the clinical pregnancy outcome of IVF-ET. There was no significant difference in clinical pregnancy rate between women aged 30~40 years with two embryos transferred and those aged<30 years with two or three embryos transferred(P>0.05). There were no significances in clinical pregnancy rate among women aged ≥ 40 years using GnRH agonist long protocol,GnRH agonist short protocol and GnRH antagonist protocol for stimulation (P>0.05).

CONCLUSIONMaternal age and number of embryos transferred have independent effect on IVF-ET clinical pregnancy outcome of secondary infertile women. We suggest that no more than two embryos should be transferred for women in their thirties to minimize the risk of multiple pregnancy while still having an acceptable pregnancy rate. The pregnancy rate of patients over 40 years decreases significantly, and there is no difference in pregnancy rate by using GnRH agonist long protocol, GnRH agonist short protocol or GnRH antagonist protocol.

Adult ; Embryo Transfer ; Female ; Fertilization in Vitro ; Follicle Stimulating Hormone ; Gonadotropin-Releasing Hormone ; agonists ; Gonadotropins ; Hormone Antagonists ; therapeutic use ; Humans ; Infertility, Female ; Maternal Age ; Ovarian Follicle ; Ovulation Induction ; Pregnancy ; Pregnancy Outcome ; Pregnancy Rate ; Retrospective Studies

Objective: To investigate the factors related to clinical pregnancy outcomes of in vitor fertilization-embryo transfer ( IVF-ET )in women with secondary infertility .Methods:The clinical , laboratory and follow-up data of 1129 cycles in 1099 patients with secondary infertility undergoing IVF-ET in Women’s Hospital, Zhejiang University School of Medicine between July 2012 to July 2014 were retrospectively reviewed.The factors related to pregnancy outcomes were analyzed by univariate and logistic regression methods .The clinical pregnancy rates in women with different age and different number of embryos transferred were compared .The clinical outcomes of stimulation with gonadotropin releasing hormone ( GnRH ) agonist long protocol , GnRH agonist short protocol and GnRH antagonist protocol were evaluated in secondary infertile patients aged≥40 years.Results: Among 1129 cycles, 376 cases( 333.0 %) had clinical pregnancy and 753 cases(66.70%)had no clinical pregnancy.There were significant differences in age , body mass index , basal follicle-stimulating hormone level , antral follicle number , paternal age and number of embryos transferred between pregnancy and no pregnancy groups(P<0.05);while only maternal age(OR=0.900, 95%CI:0 .873 ~0 .928 , P <0 .001 )and the number of embryos transferred (O R =2.248,95%CI:1.906~2.652,P<0.001)were the independent factors affecting the clinical pregnancy outcome of IVF-ET.There was no significant difference in clinical pregnancy rate between women aged 30 ~40 years with two embryos transferred and those aged<30 years with two or three embryos transferred ( P>0.05 ) .There were no significances in clinical pregnancy rate among women aged ≥40 years using GnRH agonist long protocol , GnRH agonist short protocol and GnRH antagonist protocol for stimulation(P>0.05).Conclusion: Maternal age and number of embryos transferred have independent effect on IVF-ET clinical pregnancy outcome of secondary infertile women.We suggest that no more than two embryos should be transferred for women in their thirties to minimize the risk of multiple pregnancy while still having an acceptable pregnancy rate .The pregnancy rate of patients over 40 years decreases significantly , and there is no difference in pregnancy rate by using GnRH agonist long protocol ,GnRH agonist short protocol or GnRH antagonist protocol .

BACKGROUNDLeft main coronary artery (LMCA) stenosis has been recognized as a risk factor for early death among patients undergoing coronary artery bypass grafting (CABG). This study aimed to assess if LMCA lesions pose an additional risk of early or mid-term mortality and/or a major adverse cardiac and cerebrovascular event (MACCE) after off-pump coronary artery bypass grafting (OPCABG), compared with non-left main coronary artery stenosis (non-mainstem disease).

METHODSFrom January 1, 2009 to December 31, 2010, 4869 patients had a primary isolated OPCABG procedure at Beijing Anzhen Hospital. According to the pathology of LMCA lesions, they were retrospectively classified as a non-mainstem disease group (n = 3933) or a LMCA group (n = 936). Propensity scores were used to match the two groups, patients from the non-mainstem disease group (n = 831) were also randomly selected to match patients from the LMCA group (n = 831). Freedom from MACCE in the two groups was calculated using the Kaplan-Meier method.

RESULTSThe difference in the mortality and the rate of MACCE during the first 30 days between the non-mainstem disease group and the LMCA group did not reach statistical significance (P = 0.429, P = 0.127 respectively). With a mean follow-up of (12.8 ± 7.5) months and a cumulative follow-up of 1769.6 patient-years, the difference in the freedom from MACCEs between the two groups, calculated through Kaplan-Meier method, did not reach statistical significance (P = 0.831).

CONCLUSIONAnalysis of a high volume of OPCABG procedures proved that LMCA lesions do not pose additional early and mid-term risk to OPCABG. Therefore, a LMCA lesion is as safe as non-mainstem disease lesion during the OPCABG procedure.

Adult ; Aged ; Coronary Artery Bypass, Off-Pump ; adverse effects ; mortality ; statistics & numerical data ; Coronary Artery Disease ; surgery ; Female ; Follow-Up Studies ; Humans ; Kaplan-Meier Estimate ; Male ; Middle Aged ; Retrospective Studies

Objective To rc-cvaluate and compare the research design and the use of statistical methods in Chinese Journal of Cardiology.Method Summary the research design and statistical methods in all of theoriginal papers in Chinese Journal of Cardiology all over the year of 2011,and compared the result with the evaluation of 2008.Results (1) There is no difference in the distribution of the design of researches of between the two volumes.Compared with the early volume,the use of survival regression and non-parameter test are increased,while decreased in the proportion of articles with no statistical analysis.(2) The proportions of articles in the later volume are significant lower than the former,such as 6(4％)with flaws in designs,5(3％)with flaws in the expressions,9(5％)with the incomplete of analysis.(3) The rate of correction of variance analysis has been increased,so as the multi-group comparisons and the test of normality.The error rate of usage has been decreased form 17％ to 25％ without significance in statistics due to the ignorance of the test of homogeneity of variance.Conclusion Many improvements showed in Chinese Journal of Cardiology such as the regulation of the design and statistics.The homogeneity of variance should be paid more attention in the further application.

BACKGROUNDRepair of anterior mitral leaflet (AML) prolapse is still a technical challenge for cardiac surgeons. It is an important issue to find a way to repair the AML prolapse with a reliable and reproducible technique.

METHODSBetween January 2002 and June 2009, the operation of chordal transfer based on the "edge-to-edge" technique was performed in 21 patients with serious mitral valve regurgitation because of prolapse of the anterior leaflet. After the operation, echocardiography was performed in each patient before discharge and at the time of follow-up.

RESULTSAll patients survived the operation. One patient required mitral valve replacement because of anterior leaflet perforation 3 days after the operation. The other patients were free from reoperation. At the time of follow-up, all these patients were in New York Heart Association (NYHA) functional class I. In all these patients, pre-discharge and follow-up echocardiography showed neither stenosis nor significant regurgitation of the mitral valve: the cross-sectional area of the mitral valve was 3.3 - 4.8 cm(2) (mean (3.78 ± 0.52) cm(2)), the mean regurgitation area was (0.45 ± 0.22) cm(2). At the same time, both dimension of left atrium and left ventricle reduced significantly (left atrium diameter: pre-operation (48.26 ± 11.12) mm, post-operation (37.57 ± 9.56) mm, P < 0.05; the end-diastolic diameter of the left ventricle: pre-operation (61.43 ± 8.24) mm, post-operation (42.35 ± 10.79) mm, P < 0.01).

CONCLUSION"Edge-to-edge" chordal transfer technique is a simple, reliable, and reproducible technique that can provide good results for repair of anterior leaflet prolapse of mitral valve.

Adolescent ; Adult ; Aged ; Chordae Tendineae ; surgery ; Echocardiography ; Female ; Humans ; Male ; Middle Aged ; Mitral Valve ; surgery ; Mitral Valve Prolapse ; diagnostic imaging ; surgery ; Suture Techniques